VA-*IHD LIPID PROFILE REPORTING (113)    REMINDER DEFINITION (811.9)

• EDIT DATE:   2005-03-11 12:25:19
  EDIT BY:   USER,ONE
  EDIT COMMENTS:   

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Compliance reporting measures the LDL completed within 2 years as defined 
roll up LDL compliance totals for IHD patients. This reminder 
identifies patients with known IHD (i.e., a documented ICD-9 code for 
IHD in the last five years) who have not had a serum lipid panel/LDL
(calculated or direct lab package LDL) or documented outside LDL within
the last two years. If a more recent record of an UNCONFIRMED IHD
DIAGNOSIS is found, the reminder will not be applicable to the patient.
by the VA External Peer Review Program (EPRP) performance measure and the 
maximum guideline recommended below:
  The VHA/DOD Clinical Practice Guideline for Management of Dyslipidemia 
  recommends that patients with Ischemic Heart Disease have a lipid 
  profile/LDL every one to two years; and that patients taking lipid 
  lowering medications have a lipid profile/LDL at least every year.
 
This national IHD Lipid Profile Reporting reminder is used monthly to 

• FINDING ITEM:   VA-IHD DIAGNOSIS
  USE INACTIVE PROBLEMS:   N
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN PATIENT COHORT LOGIC:   AND
  BEGINNING DATE/TIME:   T-1M
• FINDING ITEM:   VA-UNCONFIRMED IHD DIAGNOSIS
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN PATIENT COHORT LOGIC:   AND NOT
• FINDING ITEM:   VA-LIPID LOWERING MEDS
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T
• FINDING ITEM:   VA-LDL <100
  CONDITION:   I (+V<100)&(+V>0)
  INTERNAL CONDITION:   I (+V<100)&(+V>0)
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-LDL 100-119
  CONDITION:   I (+V>99)&(+V<120)
  INTERNAL CONDITION:   I (+V>99)&(+V<120)
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-LDL 120-129
  CONDITION:   I (+V>119)&(+V<130)
  INTERNAL CONDITION:   I (+V>119)&(+V<130)
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-LDL >129
  CONDITION:   I (+V>129)
  INTERNAL CONDITION:   I (+V>129)
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-LDL
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR
• FINDING ITEM:   VA-OUTSIDE LDL <100
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-OUTSIDE LDL 100-119
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-OUTSIDE LDL 120-129
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-OUTSIDE LDL >129
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR
  BEGINNING DATE/TIME:   T-2Y

• LOGIC:   FN(1)>FN(2)
  FUNCTION STRING:   MRD(1)>MRD(10)
  NO. FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0

  FUNCTION LIST:

  • FUNCTION NUMBER:   1
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   2
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

This reminder is not for use in CPRS, hence there is no related reminder 
                No mapping necessary.  Use the VA-ISCHEMIC HEART DISEASE 
  Rule 4: Anchor Visit 
     Find the subset of patients, after rule 3, with an Anchor 
     Visit 13-24 months prior to the beginning of the reporting period. 
     Use the same clinic codes used for the Qualifying Visit in Rule 2.
  Rule 5:  Associated Facility 
     The subset of patients resulting from the rules above are assigned 
     an associated facility that is used to accumulate national counts.
  
     The Associated Facility for each patient is based on the following
     criteria:
                reminder taxonomy distributed with this term.  
     1) Use the primary care facility assigned to the patient 
     2) If more than one primary care facility is assigned or no
        primary care facility is assigned, then find which facility has
        the most visits on the local VistA system in the last two years  
     3) If the count of the number of visits is the same for multiple  
        facilities, use the facility associated with the most recent 
        visit between the tied facilities.
     
Reporting roll up will send totals for this reminder and facility for: 
  1) Reminder totals based on reminder evaluation:
     
     applicable, not applicable, due, not due totals
  2) Finding totals for most recent counts from the group of LDL
     findings, based on Lab or Outside LDL findings:
         LDL <100 
         LDL 100-119 
         LDL 120-129 
         LDL >129 
         OUTSIDE LDL <100 
         OUTSIDE LDL 100-119 
         OUTSIDE LDL 120-129 
    UNCONFIRMED IHD DIAGNOSIS 
         OUTSIDE LDL >129 
     The finding totals are based on reminder evaluation findings for 
     applicable patients using the reminder definition.
  3) Finding totals for most recent counts from the group of IHD Diagnosis
     and Unconfirmed IHD Diagnosis findings.
         IHD DIAGNOSIS
         UNCONFIRMED IHD DIAGNOSIS   
  4) Finding totals for most recent count of patients who have active
     Lipid Lowering Agents within the reporting period.
      
                Use the UNCONFIRMED IHD DIAGNOSIS health factor 
CPRS vs. Reporting reminders: This VA-*IHD LIPID PROFILE REPORTING
reminder does not include orders placed, refused, or other defer
activities which clinicians use in CPRS to manage the VA-IHD LIPID 
PROFILE clinical reminder. This Reporting reminder is restricted to Lab
results and Pharmacy medications found during the reminder evaluation 
for each patient in the denominator patient list.
                distributed with this term or add any local health 
                factor representing an unconfirmed or incorrect IHD 
                diagnosis.  
     
   LDL          Enter the Laboratory Test names from the Lab Package 
dialog.  
                for calculated LDL and direct LDL with "I +V>0" in the
                CONDITION field.
 
                The Lab tests defined in this term will be used to update 
                the following reminder terms findings: 
                     LDL <100 
                     LDL 100-119 
                     LDL 120-129 
                     LDL >129 
 
     
   For the following OUTSIDE LDL Reminder Terms, use the health factors 
   distributed with these reminder terms or add local health factors 
   or other findings to the appropriate reminder terms. The findings 
   should represent LDL values from a source outside the local facility.
 
         OUTSIDE LDL <100 
             Distributed with health factor OUTSIDE LDL <100
         OUTSIDE LDL 100-119 
             Distributed with health factor OUTSIDE LDL 100-119
         OUTSIDE LDL 120-129
Setup issues before using this reminder: 
             Distributed with health factor OUTSIDE LDL 120-129
         OUTSIDE LDL >129
             Distributed with health factor OUTSIDE LDL <129
 
   LIPID LOWERING MEDS 
                Enter the formulary drug names for investigation drugs.  
                Mapping non-investigative formulary drugs to the 
                VA-GENERIC drugs will ensure the lipid lowering 
                medications are found. The medications are informational 
                findings for this reminder.  
     
     
     
National Roll-up: 
The national reporting criteria for VA-IHD QUERI are defined in the
Reminder Extract Parameter file.
 
This national reminder is used by the VA-IHD QUERI Extract run monthly
to roll up compliance totals for LDL laboratory tests completed within 
the past 2 years. The patients evaluated for compliance are based on VA
EPRP performance measure reporting criteria. The performance measure
 1. Use the Reminder Term options to map local representations of 
reporting criteria are used to create patient lists.  The patient 
lists used with this reminder are found in the Reminder Patient List 
file with the following naming conventions:
   VA-*IHD QUERI yyyy Mnn PTS WITH QUALIFY AND ANCHOR VISIT
   VA-*IHD QUERI yyyy Mnn PTS WITH QUALIFY AND ANCHOR VISIT ON LLA MEDS
   where yyyy is the calendar year, and nn is the month.
 
The patient lists are based on two different Extract Finding Rule Sets:
   VA-*IHD QUERI PTS WITH QUALIFY AND ANCHOR VISIT
   VA-*IHD QUERI PTS WITH QUALIFY AND ANCHOR VISIT ON LLA MEDS
    findings: 
The rule sets will find IHD patients of record within 5 years prior to
the beginning of the monthly reporting period who had a qualifying
clinic visit and an earlier (anchor) visit 13-24 months prior to the
reporting period.  The patient list with ON LLA MEDS finds those patients 
who have had a supply of Lipid Lowering Agent Medications in VistA during 
the reporting period.
 
Rules for building the patient list for the reporting patient 
denominator are:
 
     
  Rule 1: IHD Patients
     Start with Patients with an IHD 410.nn, 411.nn, 412.nn, or 
     414.nn diagnosis documented within 5 years prior to the beginning of 
     the reporting period. 
  Rule 2: Qualifying Visit
     Find the subset of patients, from rule 1, who have a Qualifying 
     Visit during the one-month reporting period.  
     Qualifying Clinic Codes include: 
       Primary Care: 301 (General Internal Medicine), 322 (Women), 323  
                     (Primary Care/Medicine), 350 (Geriatric), 531 and 
   IHD DIAGNOSIS 
                     563 (Mental Health Primary Care)
       Specialty Care: 303 (Cardiology), 305 (Endocrinology/ Metabolism), 
                    306 (Diabetes), 309 (Hypertension), 312 
                    (Pulmonary/Chest)
       Include patients that had a Qualifying Visit during the reporting 
       period and subsequently died before or after the end of the
       reporting period.
  Rule 3:  Exclude patients from the patient subset resulting from  
     Rule 2 that have a primary discharge diagnosis of 410.nn within 60
     days prior to the Qualifying Visit.

• URL:   http://www.oqp.domain.ext/cpg/DL/dl_cpg/algo4frameset.htm
  WEB SITE TITLE:   VHA/DoD CPG for Dyslipidemia
  WEB SITE DESCRIPTION:   

  The VHA/DoD CPG for Management of Dyslipidemia is a comprehensive 
  guideline incorporating current information and practices for 
  practitioners throughout the DoD and Veterans Health Administration 
  system. See Section S, Table 3b for reference to LDL<120 in the 
  Guideline.
  

• REMINDER FREQUENCY:   2Y
  NO. OF AGE MATCH LINES:   0
  NO. OF AGE NO MATCH LINES:   0